The Risk Factor of Ligamentum Flavum Thickness, Disc Herniation Degree, Intervertebral Disc Space Narrowing, and Stenosis Level for the Severity of Neurogenic Claudication in Lumbar Spinal Canal Stenosis Patients

Introduction: Lumbar Spinal Canal Stenosis (LSCS) is a degenerative spinal condition associated with the mechanical compression of spinal nerve roots, often leading to neurogenic claudication. This study aims to evaluate the roles of ligamentum flavum thickness, disc herniation degree, disc height narrowing, and stenosis level as risk factors for the development of neurogenic claudication in LSCS patients. Material & methods: This case-control study was conducted at RSUP Prof. I.G.N.G. Ngoerah, Denpasar, involving LSCS patients diagnosed via MRI. Data were collected from 36 participants using the total consecutive sampling method. Ligamentum flavum thickness (>3.1 mm), disc height narrowing (<10.5 mm), disc herniation degree, and stenosis level (single-level or multi-level) were evaluated as predictors of the Neurogenic Claudication Outcome Score (NCOS). Results: The results showed that disc herniation with extrusion posed a significantly higher risk of neurogenic claudication (p < 0.001) compared to protrusion-type herniation. Patients with disc height narrowing <10.5 mm were also at higher risk (p = 0.003). However, ligamentum flavum thickness >3.1 mm (p = 0.939) and multi-level stenosis (p = 0.09) did not significantly increase the risk of neurogenic claudication. Regression analysis concluded that the degree of disc herniation was the primary risk factor for neurogenic claudication among the other assessed factors in LSCS patients. Conclusions: The degree of disc herniation and disc height narrowing are key risk factors for the development of neurogenic claudication in LSCS patients. These findings emphasize the need for a comprehensive diagnostic and therapeutic approach by integrating both clinical and radiological evaluations. Keywords: Lumbar spinal stenosis, neurogenic claudication, ligamentum flavum hypertrophy, MRI diagnostics, disc herniation severity